Does Hormone Replacement Therapy (HRT) Have A Beneficial Or Detrimental Effect On Cardiovascular Outcomes In Postmenopausal Women? A Systematic Review On The Evaluation Of Risk And Effectiveness

Abstract

Background: Hormone Replacement Therapy (HRT) involves the supplementation or substitution of hormones, such as estrogen and progesterone, to alleviate menopausal symptoms. However, its impact on cardiovascular diseases (CVDs) has been widely debated. CVDs remain the leading cause of mortality worldwide, necessitating early detection, prevention strategies, and effective management. Initially, HRT was believed to provide cardiovascular benefits by improving cholesterol levels and arterial function. However, subsequent research has produced conflicting findings. Some studies suggest HRT increases the risk of cardiovascular events, such as blood clots and strokes, while others indicate potential benefits. Consequently, the decision to use HRT for CVD prevention requires careful risk assessment and individualized consultation with healthcare providers.

Objective: To systematically evaluate the impact of Hormone Replacement Therapy (HRT) on cardiovascular outcomes in postmenopausal women, assessing both its benefits and risks.

Methods: A systematic review of literature was conducted, analyzing 53 articles from reputable journals published between January 1, 2018, and August 13, 2023. Eight studies were selected for in-depth analysis. The review focused on distinct cardiovascular conditions in menopausal women, considering both those with and without prior CVDs or associated risk factors, as well as the effects before and after HRT administration.

Results: Vaginal HRT reduces the risk of heart attack and stroke, whereas oral HRT has no significant effect on heart disease. Higher dosages of oral or transdermal HRT may increase the risk of stroke and venous thromboembolism (VTE). Transdermal estradiol (t-E2), either alone or combined with micronized progesterone, lowers the risk of thromboembolism. Unlike t-E2, oral conjugated equine estrogen (o-CEE) helps mitigate the negative effects of increased pericardial adipose tissue on atherosclerosis progression. According to the Timing Hypothesis, the cardiovascular effects of HRT vary based on the age of initiation, with younger women potentially experiencing greater benefits.

Conclusion: Low-dose HRT and oral administration appear safer for individuals at higher risk of stroke and blood clots. The use of transdermal estradiol and progesterone may lower the risk of thromboembolism, while o-CEE slows atherosclerosis progression. Additionally, earlier initiation of HRT is associated with a reduced risk of CVD. However, individualized decision-making remains essential, and further research is necessary to fully understand HRT’s cardiovascular implications in postmenopausal women.